Second Florida insurer strikes deal with state over HIV drugs

Tony Smith, who was diagnosed with HIV in 2008, is worried he may not be able to afford his medication costs under ACA coverage for 2015. Here Smith sorts through insurance papers at his home in Coral Springs on Oct. 22.
Al Diaz
MIAMI HERALD STAFF

Tony Smith, who was diagnosed with HIV in 2008, is worried he may not be able to afford his medication costs under ACA coverage for 2015. Here Smith sorts through insurance papers at his home in Coral Springs on Oct. 22.
Al Diaz
MIAMI HERALD STAFF

In the wake of a federal civil rights complaint alleging that four Florida insurers discriminated against people with HIV/AIDS, Coventry Health Care has reached a deal with state regulators to reduce the costs of its HIV drugs for some Florida residents signing up for health insurance under the Affordable Care Act.

Cigna agreed to a similar arrangement with the Florida Office of Insurance Regulation two weeks ago.

As part of the deal, both insurers will cap the amount consumers pay for four widely prescribed medications — Atripla, Complera, Stribild and Fuzeon — at $200 a month for 2015 plans offered on the federal healthcare exchange. The companies also agreed to move their generic HIV drugs from a more expensive “specialty” tier to a less expensive tier for generics.

The complaint, filed in May by the Tampa-based AIDS Institute and the National Health Law Program in Washington, D.C., accused the insurers of making their HIV drugs so expensive for 2014 plans that consumers could not afford them.

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Florida law prevents insurers from discriminating against those with HIV.

The U.S. Department of Health and Human Services is still investigating the complaint, which also named Humana and Preferred Medical.

Neither Cigna nor Coventry admitted to any wrongdoing in their agreements with the state. “We are voluntarily updating our plans in order to ensure we are compliant with Florida law,” said Walt Cherniak, a spokesman for Aetna, which owns Coventry.

Even with the deal, consumers may still have trouble paying for the medications their lives depend on.

Tony Smith, 42, of Coral Springs, was diagnosed with HIV in 2008. He said under his current Cigna plan he pays $85 for a three-month supply of Atripla. But Cigna isn’t offering that plan next year and Smith will need to sign up for new insurance on the federal exchange.

“Two hundred dollars a month just isn’t realistic for me,” said Smith, a self-employed notary. “There’s no way I can afford that.”

Smith said he may be forced to reduce his income in order to qualify for the federal Ryan White HIV/AIDS program, which would pay all his medication costs.

The health advocacy groups that filed the complaint insist the federal government must address the problem.

“What we want to see are standards being articulated and applied across the nation,” said Wayne Turner, a staff attorney with the National Health Law Program.

And Cigna and Coventry aren’t capping costs for consumers in other states where they offer plans, pointed out Carl Schmid, deputy executive director of the AIDS Institute.

“There is still a macro issue of patient access to care that hasn’t been resolved,” Schmid said.

This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.